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Regional Oncology Update - Spring 2003

MammoSite RTS (Radiation Therapy System) for Treatment of Breast Cancer
Over the last 15 years breast conserving therapy (lumpectomy followed by radiation therapy) has become the treatment of choice for managing patients with early stage breast cancer.

The long-term disease free and overall survival for breast conserving therapy and modified radical mastectomy are identical. The course of post lumpectomy whole breast external beam radiation therapy followed by a boost to the tumor bed generally requires approximately 6 weeks to complete. Studies found there are patients that don't complete the post surgical radiation therapy due to several factors.

Two of the most often cited reasons for noncompliance were the amount of time necessary to complete radiation therapy and transportation difficulties for those living in rural communities. An effort to increase compliance with radiation therapy while maintaining long term local control and overall survival rates of conventional whole breast radiation resulted in the design of an applicator (MammoSite Radiation Therapy System) by which to deliver high dose rate brachytherapy post-operatively. High dose rate brachytherapy delivered via the MammoSite applicator treats the post-operative lumpectomy site instead of irradiating the whole breast. Appropriately selected patients with Stage I and Stage II breast cancer have experienced results equivalent to external beam therapy. The FDA approved the clinical use of the MammoSite Radiation Therapy System to facilitate partial breast irradiation utilizing high dose rate brachytherapy in May of 2002.

Indications for this modality include; 45 years of age or older, infiltrating duct carcinoma pathology, tumor less than 3 cm, negative lumpectomy margins, and absence of an extensive intraductal component, lobular carcinoma or pure ductal carcinoma in situ (DCIS).

The MammoSite applicator uses radioactive 192 Iridium to treat the lumpectomy site in a predictable and reproducible manner. This device simplifies the physics and treatment planning necessary for the delivery of a shortened course of therapy in a standardized fashion. The applicator is comprised of a balloon catheter that facilitates the administration of a prescribed dose of radiation to targeted breast tissue (lumpectomy cavity) in a five-day course of therapy.

During the lumpectomy, the deflated MammoSite balloon is placed inside the tumor resection cavity. Once in place, the balloon is inflated with saline to conform to the cavity. The balloon remains inflated and fixed in position for the entire time that the patient is receiving radiation therapy. The applicator shaft, a catheter connected to the balloon, remains outside the breast for access to the radioactive source. The treatment consists of a radioactive seed of 192 Iridium temporarily inserted within the inflated balloon to deliver a localized dose of radiation.

The actual treatment time for each session is about 10 minutes. No source of radiation remains in the patient's body between the treatments or after completion of treatment. This form of therapy requires only 5 treatment days with 2 fractions each day 6 hours apart. The MammoSite balloon is deflated and removed following the tenth and final fraction. The patient has then completed the full course of post lumpectomy partial breast irradiation in 5 treatment days compared to equivalent external beam therapy requiring approximately 6 weeks.

The treatment is extremely well tolerated with no systemic side effects and minimal skin reaction and fatigue. The MammoSite Radiation Therapy System offers great convenience and is especially appealing to patients who live a considerable distance from a radiation oncology center.

The Evansville Cancer Center has utilized high dose rate brachytherapy since 1983 and has extensive experience with breast, lung, prostate, GYN, and head and neck cancer implants. Therefore, we were invited to attend the first clinical treating session for the MammoSite Radiation Therapy System and were among the first facilities in the United States to administer this therapy. We are currently enrolled in a clinical trial to evaluate and study MammoSite treatment.

I want to give special recognition and thanks to Drs. David Carlson, Brian Schymik, and Santi Vibul for their surgical expertise, cooperation, and enthusiasm for this treatment modality.

If you would like more information about MammoSite RTS for treatment of breast cancer, call me at (812) 474-1110.

- Shannon Lamb, M.D., Radiation Oncologist

Dr. Lamb is a Radiation Oncologist specializing in breast cancer treatment. She has been practicing medicine in the Tri-State area since 1977. Dr. Lamb graduated from the University of Louisville School of Medicine and completed her residency in Radiation Therapy at The Radiation Center in Louisville, Kentucky. She is board certified by the American Board of Radiology in Therapeutic Radiology.
On Complimentary Medicine
Though a popular version of complementary medicine may conjure up images of brown rice in bowls and practitioners in robes, the scientific point of view suggests a simpler and more mid-western picture.

Taking care of one's patients emotional needs, and optimizing their coping in a variety of common sense interventions, finds more support in the complementary medicine literature than do dietary interventions, herbal combinations, Reiki or any of the other forms of ”energy medicine.” We are trying to reverse the growth tumors that are already present, not merely set up a mind-body state that makes the healthy patient more healthful. To the extent the journals report cancer patients living longer and not just better as a result of adding complementary medicine options, it is usually a psychological or social intervention that has made the difference.

Reducing side effects of treatment, boosting adherence to treatment, and general improvements in well-being are well documented in the literature. Almost as well documented is the relationship between negative mood or excessive anxiety and the severity of treatment side effects, noncompliance, even ill-advised discontinuation of treatment. Fewer, but still convincing, studies further indicate predictive links between negative mood and later morbidity, cancer recurrence and mortality.

For all the above reasons, our choice of how to integrate complementary medicine offerings at the Evansville Cancer Center is psychology based. I am on site and available to patients and families 30 hours each week. This availability allows for the immediate interventions, and for the frequent informal exchanges which help prevent more serious emotional deterioration. The atmosphere of caring treatment, and clear concern for the whole person already one of the Center's hallmarks is enhanced through the psychologists joining with the family and treatment team at key junctions in the treatment process. This, as much as the formal scheduled offerings defines our patient and family focused approach.

- Andrew Dixon-Reed, Ph.D.

Formerly clinical coordinator of Mulberry Center’s outpatient offices and clinical director of a doctoral residency in clinical psychology, Dr. Andrew Dixon-Reed joined the Evansville Cancer Center in 2001. One of the few board certified psychologists in the region (American Board of Professional Psychology), Dr. Dixon-Reed brings a blend of clinical expertise, compassion and common sense. Beyond this, for our patients whose view of complementary medicine looks to the East, Dr. Dixon-Reed coaches patients desiring it in T’ai Chi, Qi Gong and meditation.
St. Mary's Medical Center Honors Dr. Al Korba for
Twenty-Five Years of Oncology Service
On Saturday evening, April 5, 2003, St. Mary's Medical Center hosted their annual Physicians Recognition banquet at Evansville Country Club. Dr. Al Korba, Radiation Oncologist, was honored with an award for twenty-five years of service.

Dr. Korba has been internationally recognized as a pioneer in the development of High-Dose Radiation. In 1992, he received the Kurt Sauerwein International Award for his work in brachytherapy and is a frequently requested lecturer. Dr. Korba is a Fellow of the American College of Radiation Oncology.
“Bob Dole Speaks Out” at Prostate Cancer Awareness Program
Scheduled for August

Evansville Cancer Center is excited to announce The Honorable Robert Dole will be in Evansville for this year's prostate cancer awareness program.

He is a distinguished national leader, respected senior statesman and a brilliant legislator with international acclaim, Bob Dole will offer first hand accounts and antidotes of the challenges we have and will face as a nation. As a prostate cancer survivor, he will be sharing the story of his personal battle with prostate cancer emphasizing the importance of early detection for this disease. This year's program, “Bob Dole Speaks Out”, will be entertaining and challenging.

September is National Prostate Cancer Awareness Month. Evansville Cancer Center and Tri-State area urologists in cooperation with The American Cancer Society will team together once again to present to our community “Bob Dole Speaks Out”, an educational program that addresses prostate cancer (and more). The program is scheduled for Saturday, August 23rd at 2:00 p.m. at The Centre in downtown Evansville. Last year when we hosted “Strike Out Prostate Cancer with Bob Gibson” over 600 people in attended, we established and met our goals; to raise prostate cancer awareness, to teach men the importance of taking charge of their health, and to promote early detection of cancer and treatment.

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